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   2018| July-December  | Volume 20 | Issue 2  
    Online since December 23, 2019

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Operative Challenges in Doing Cochlear Implant in an Ossified Cochlea, is it Worth it? Case Report and Reviewing the Literature
Farid Alzhrani
July-December 2018, 20(2):68-73
Objectives: To present an unusual way of cochlear implant electrode insertion and discuss the audiological as well as the speech outcome. Study Design: Case report. Method: Will be reviewing a file of a deaf patient who underwent retrograde insertion of cochlear implant array. Once the audiological and speech findings are evaluated then the literature for similar cases and alternative techniques will be discussed. Results: A case of a 24-year-old male patient that underwent cochlear implantation due to post meningitis deafness. Considering an ossified cochlea a cochlear implant array was inserted in a retrograde manner from the apex toward the basal turn of the cochlea. There was neither an intraoperative nor postoperative complication. The post implantation audiological outcome was comparable with those subjects who have no ossification in the cochlea. The patient started to use a mobile phone 4 months post- op. 76% speech discrimination score at 60 dB has been achieved within 5 months post implantation. Conclusion: The apical cochleostomy with descending cochlear implant array insertion is an efficient procedure that has very good postoperative results.
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Impact of Flab Technique Versus Non-Flap Techniques on Endoscopic Dacryocystorhinostomy
Fahd Alharbi, Sherif Kamel, Bassam El-Zuraiqi
July-December 2018, 20(2):46-48
Objective: to compare the influence of flap versus non-flap technique on endoscopic dacryocystorhinostomy (EDCR). Patients and Method: A prospective randomized trial in patients with bilateral nasolacrimal duct obstruction, comparing the two techniques to avoid inter-patient variability. We included all patients where bilateral epiphora, excluding unilateral, previously operated or recurrent cases. Results: One hundred patients, fifty females and fifty males with bilateral epiphora due to naso-lacrimal duct obstruction were operated upon by EDCR with or without flap technique. Out of 100 EDCR procedures with flap technique, only 3 had recurrent epiphora with stenosis of the ostium on endoscopic examination and failed fluorescein dye test. In contrast, 4 procedures without flap failed as evident by recurrent epiphora, endoscopic and fluorescein dye test criteria. Conclusion: There is no difference between DCR with flap preservation and flap removal in success rate but the preservation of both lacrimal and mucosal flaps aids in reducing the post-operative granuloma development.
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Recurrent Tympanostomy Tube Insertion for Chronic Otitis Media with Effusion in Children and the Effect of Concurrent Adenoidectomy on the Outcome.
Abdulmonem Al-Shaikh, Rawan Mandura, Ola Bafail
July-December 2018, 20(2):62-67
Purpose: To determine the incidence of recurrent tube insertion in our region and to study the effect of adenoidectomy in concurrent with 1st tube insertion surgery on the outcome in our target population. Methods: Retrospective medical chart review was performedfor all children between the age of 6 mo-12 years, who underwent tympanostomy tube insertion due to otitis media 2014 at a referral hospital; Otolaryngology specialized center at King Fahad Hospital, Jeddah, Saudi Arabia. Information regarding initial and repeated tympanostomy tube placement from the medical records. Because of incomplete records for at risk children (children at risk for otitis media with effusion due to presence of bronchial asthma, Down’s syndrome, cleft palate, craniofacial malformation), all at risk children were excluded from our analysis. To study the effect of age and gender on the need for repeated sets of tube insertion, our population was divided in two groups as follow: Group A (children from 6mo to 4years; n= 131) and Group B (children form 4 years and 12 years; n= 232). To study the effect of adenoidectomy in concurrence with first set of tube insertion; our population was divided further into two groups: group I (tube insertion + adenoidectomy) and group II (tube insertion alone). Results: Three hundred and sixty three children were included in this study. Forty six (12.7%) of the 363 children who underwent initial tympanostomy tube insertion subsequently required another set of tubes insertion as follows: thirty one (8.5%) children required two sets of tube insertion, fourteen (3.9%) required three sets, one child (0.3%) required four sets. Age and gender showed a non significant difference between the two groups, group A and group B(Chi-square =0.73, P = 0.24; Chi-square = 0.28, P= 0.35 respectively). A total of 208 out of 363 patients underwent adenoidectomy in concurrent with the first set of tube insertion. One eighty seven (89.9%) of them required only one set; 21(10.1%) required more than one set. The remaining 155 patients underwent tubes insertion alone, without adenoidectomy. One thirty (83.9%) of them required only one set; 25(16.1%) required more than one set. There were no significant difference between the two groups, group I and group II, in regard to both the need for repeated use and the frequency of tube usage (chi-square = 2.91, 4.71, P = 0.087, 0.195 respectively) Conclusions: In our region, repeated use of tympanostomy tube insertion for otitis media with effusion carry a considerable incidence. Adenoidectomy performed at the fist set of tube insertion does not show a significant effect on the risk of repeated tube insertion. In as well as potential risk factors for otitis media were extracted addition, age (at the first tube insertion) and gender have no clear role on the need for repeated tube usage.
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Neck Pain Among Otolaryngologists, Head and Neck Surgeons
Ahmed Alem, Lujain Abdalwassie, Abdallah Abdulkarin Alharbi, Elaf Alaadah, Amro Hamdi, Talal Al- Khatib
July-December 2018, 20(2):56-61
Introduction: Neck pain is one of the most frequent complaints among the general population, especially for health care professionals and otolaryngologists, who are likely to develop work-related neck pain . Objective: To determine the prevalence of neck pain among otolaryngologists and head and neck surgeons (ORL HNS). This study also aimed at assessing the effects of neck pain on overall quality of life. Subjects and Methods: A cross-sectional study was conducted during the 10th International Saudi Otorhinolaryngology Head & Neck Surgery Conference in March 2016, Jeddah, Saudi Arabia. The study included ORL HNS. Results: A total of 92 ORL HNS participated in the survey. General ORL doctors comprised the majority of respondents (32.6%), followed by rhinologists (28.3%). Most physicians (48.9%) had practiced for 5–20 years. A high proportion of respondents (81.4%) complained of neck pain; of these, 14.1% reported that this symptom was affecting their work. Some respondents reported stiffness (49.2%), weakness (5.1%), or paresthesia (8.5%). The Neck Disability Index showed that 34.8% of the respondents had mild disability; 54.3% had moderate disability whereas 10.9% had severe disability. Conclusion: The number of surgery days per month and duration of practice appeared to affect physicians’ quality of life, suggesting that workload increases neck symptoms.
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Relation Between Smoking and Nasopharyngeal Carcinoma at Assir Region, South of Saudi Arabia
Jibril Hudise, Khalid Alshehri, Ibrahim Sumaily, Nasser Maqbool, Wafa Alshehri, Ashwaq Asiri, Bayan Al jobran, Abdrahman Alshehri
July-December 2018, 20(2):51-55
Introduction: Nasopharyngeal carcinoma arises from the epithelium that covers the nasopharyngeal mucosa. A variety of risk factors have been correlated with nasopharyngeal carcinoma, including alcohol, tobacco, Cantonese-style salted fish, occupational exposures and herbal drugs. Objectives : This was a retrospective study made to assess the relation between smoking and nasopharyngeal carcinoma and affect of smoking on nasopharyngeal carcinoma at Assir Region conducted in Assir Central Hospital, Abha, Saudi Arabia. Methods: During a 5-year period (2011–2016), the medical records of patients with nasopharyngeal masses were collected from the department of pathology at Aseer Central Hospital .The cases were reviewed for data on gender ,age, the pathology, family history and history of smoking. Results: Over a period of 5 years, a total of 105 patients :68 men and 37 women who had nasopharyngeal masses were studied for pathological assessments. The age of presentation was ranging from 6 to 92 years. The histopathological diagnosis of the nasopharyngeal masses were: reactive lymphoid hyperplasia in 62.7%, nasopharyngeal carcinoma (NPC) 31.4%,tuberculosis (TB) 1%, Warthin tumor 1%, non Hodgken lymphoma 2.9% and rhabdomyosarcomal 1%. In NPC, never smokers were 42.4%, current smokers 36.4% and Ex-smokers 21.2%. while in reactive hyperplasia, never smokers 81.8%, current smokers 12.1% and Ex- smokers 6.1%. Conclusions : Nasopharyngeal carcinoma has proved to be the most common type of nasopharyngeal cancer arising from the epithelial cells that line the nasopharynx. Smoking is strong risk factor in cases of nasopharyngeal carcinoma.
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Kamal J. Daghistani
July-December 2018, 20(2):45-45
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